Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Sonnenblick, M; Rosin, Arnold J.

doi:10.1136/pgmj.62.728.449

Cited by 37 publications

(32 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although water intake was not measured, these authors suggested that thiazides may cause polydipsia which, when combined with the renal effects of thiazides, results in an expansion of total body water and hyponatremia. Sonnenblick and Rosin [22] also found evidence of water retention in thiazide-induced hyponatremia: they showed that some patients have low serum uric acid levels and high uric acid clearances (a marker of volume expansion) which return to normal as the serum sodium concentration rises. Similarly, Abramow and Cogan [4] found that in some of their patients the fractional urea excretion was high during hyponatremia and fell with correction of the serum sodium.…”

Section: Mechanismsmentioning

confidence: 99%

“…However, because thiazides interfere with renal water excretion, they impair this normal osmoregulatory response. Thus, as in most patients with hyponatremia, urine osmolality is inappropriately high relative to the osmolality of plasma and often exceeds it [1,4,12,17,22,23,25,28]. In fact, rejected cations may sometimes be excreted at a total concentration which exceeds that of plasma [17].…”

Section: Mechanismsmentioning

confidence: 99%

“…While some patients are volume depleted on presentation, most appear to be euvolemic [3,4,12,[22][23][24][25][26]. Serum levels of creatinine, blood urea nitrogen, and uric acid are often normal and sometimes low.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Diuretic-Induced Hyponatremia

Spital

1999

Am J Nephrol

119

View full text Add to dashboard Cite

Diuretics are one of the most common causes of severe hyponatremia. Yet, despite several relevant studies and years of clinical experience, the mechanism and optimal treatment of diuretic-induced hyponatremia remain unclear. What is clear is that most cases are caused by thiazide rather than loop diuretics and that severe hyponatremia can develop very rapidly in susceptible patients. In this review, I will discuss the pathogenesis, clinical features, prevention, and treatment of diuretic-induced hyponatremia in the hope that increased awareness and understanding will reduce the incidence and complications of this potentially life-threatening syndrome.

show abstract

Section: Mechanismsmentioning

confidence: 99%

Section: Mechanismsmentioning

confidence: 99%

See 1 more Smart Citation

Diuretic-Induced Hyponatremia

Spital

1999

Am J Nephrol

119

View full text Add to dashboard Cite

show abstract

“…3,18,19 and when hyponatremia does develop while taking a loop diuretic, it is more likely due to sodium loss than to free water retention, unless fluid intake is very high. 20 potassium-sparing diuretics act at the distal diluting sites, adding to the impairment of dilution associated with administration of a thiazide. these include the mineralocorticoid receptor antagonists spironolactone and eplerenone, as well as triamterene and amiloride, which act directly in the distal tubule.…”

Section: Thiazide Diuretics Vs Other Diureticsmentioning

confidence: 99%

The Silent Epidemic of Thiazide‐Induced Hyponatremia

Mann

2008

J of Clinical Hypertension

View full text Add to dashboard Cite

(Greenwich). 2008;10:477-484 . © 2008 Le Jacq C onsiderable attention is paid to the problem of thiazide-induced hypokalemia. Much less attention is paid to thiazide-induced hyponatremia (tih), which is seen with considerable frequency. tih occurs predominantly in the elderly.1-4 as a result, it is not encountered in the data of large drug treatment trials that involve predominantly younger patients. however, in the systolic hypertension in the Elderly program (shEp), which focused on older patients, hyponatremia (defined as a sodium level <130 mEq/L) was observed in 4.1% of patients treated with chlorthalidone vs 1.3% in the control group, while hypokalemia (potassium level <3.2 mEq/L) was observed in 3.9% of patients in the treatment group.5 thirty percent of patients were receiving 12.5 mg of chlorthalidone, and 60% were receiving 25 mg.5 in another study in the elderly, diuretic-induced hyponatremia, defined as a serum sodium concentration ≤130 mEq/L, was seen in 17% and hypokalemia in 6.6%.6 fiftythree percent of patients were receiving a thiazide diuretic and 24% a loop diuretic. 6 in patients with tih, an average daily hydrochlorothiazide dose of 35 mg has been reported, with 44% of patients having received ≥50 mg.7 however, in 10% of cases the dose was only 12.5 mg.8 the risk of tih is 3-fold higher in persons older than 70 years and is higher among women, possibly because of smaller body size or lower sodium intake.2,3 With the high prevalence of hypertension in the elderly and the routine use of thiazide diuretics to treat it, tih is clearly a prevalent problem.CLINICAL PRESENTATION tih can develop acutely or gradually. it can range from mild to severe and from asymptomatic to symptomatic. the onset is within 2 weeks of starting the diuretic in 50% to 90% of cases, but it can occur within a day or two or even after a single dose.3,7-9 hyponatremia can occur after months or years of taking a thiazide and is likely related to subsequent contributory factors such as reduction of R e v i e w P a p e r

show abstract

“…According to these sources, the majority of patients appear clinically euvolemic and typically present with biochemical features of extracellular fluid volume expansion, that is, low or low-normal serum creatinine and serum uric acid, and urine sodium concentration greater than 20 mEq/L [17,18,19,20]. This similarity with the typical picture of the syndrome of inappropriate antidiuretic hormone secretion (SIADH), the most frequent cause of hyponatremia, makes it difficult to distinguish these two disorders on clinical or biochemical grounds.…”

Section: Introductionmentioning

confidence: 99%

Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An Observational Multicenter International Study

et al. 2017

View full text Add to dashboard Cite

Background: Hyponatremia is a frequent and potentially life-threatening adverse side effect of thiazide diuretics. This sub-analysis of the Hyponatremia Registry database focuses on current management practices of thiazide-associated hyponatremia (TAH) and compares differences between TAH and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Methods: We analyzed 477 patients from 225 US and EU sites with euvolemic hyponatremia ([Na⁺] ≤130 mEq/L) who were receiving a thiazide diuretic. Of these, 118 met criteria for true thiazide-induced hyponatremia (TIH). Results: Thiazide was withdrawn immediately after hyponatremia was diagnosed only in 57% of TAH; in these patients, the median rate of [Na⁺] change (Δ_daily[Na⁺]) was significantly higher than those with continued thiazide treatment (3.8 [interquartile range: 4.0] vs. 1.7 [3.8] mEq/L/day). The most frequently employed therapies were isotonic saline (29.6%), fluid restriction (19.9%), the combination of these two (8.2%), and hypertonic saline (5.2%). Hypertonic saline produced the greatest Δ_daily[Na⁺] (8.0[6.4] mEq/L/day) followed by a combination of fluid restriction and normal saline (4.5 [3.8] mEq/L/day) and normal saline alone (3.6 [3.5] mEq/L/day). Fluid restriction was markedly less effective (2.7 [2.7] mEq/L/day). Overly rapid correction of hyponatremia occurred in 3.1% overall, but in up to 21.4% given hypertonic saline. Although there are highly significant differences in the biochemical profiles between TIH and SIADH, no predictive diagnostic test could be derived. Conclusions: Despite its high incidence and potential risks, the management of TAH is often poor. Immediate withdrawal of the thiazide is crucial for treatment success. Hypertonic saline is most effective in correcting hyponatremia but associated with a high rate of overly rapid correction. We could not establish a diagnostic laboratory-based test to differentiate TIH from SIADH.

show abstract

Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Cited by 37 publications

References 11 publications

Diuretic-Induced Hyponatremia

Diuretic-Induced Hyponatremia

The Silent Epidemic of Thiazide‐Induced Hyponatremia

Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An Observational Multicenter International Study

Contact Info

Product

Resources

About